Find TRICARE Options that Fit Your Health Care Needs
Health services come in many forms. Sometimes it means going to your doctor for a routine checkup. Other times it means getting care from a specialty provider, like a dermatologist or cardiologist. But what if you need care for an extended amount of time? While TRICARE doesn’t cover long-term care (also known as custodial careNon-skilled, personal care for basic day-to-day tasks. This includes help with eating, dressing, getting in or out of a bed or chair, moving around, and using the bathroom.), it does cover other specialty care services you may need to support your unique health care needs.
What’s long-term custodial care?
Long-term custodial care services are used to fulfill your health or personal care needs for a period of time. It includes care for patients with cognitive disorders or prolonged illnesses, like Alzheimer’s disease. Some functions of long-term care include home-based services to help people with daily living (dressing or bathing) and supervision to make sure they’re safe. While custodial care facilities aren’t used to return a patient to wellness, they do help maintain a patient’s current level of fitness for an indefinite length of stay.
According to the National Institute on Aging (NIA), it can be difficult to predict how much or what type of long-term custodial care someone might need. But several factors affect whether you may need it:
- Marital status
- Health and family history
As you make health care decisions for you and your family, don’t forget about the importance of healthy living and preventive care. Eating a nutritious diet, exercising regularly, and not smoking, can benefit your overall health. Planning in advance can make a difference, too. “Talk with your family, friends, and lawyer about who would provide care if you needed help for a long time,” the NIA recommends.
What are my options with TRICARE?
Although long-term custodial care isn’t a covered TRICARE benefit, you do have access to other covered services you may need, including:
- Skilled nursing care
- Durable medical equipment
- Home health care
- Respite care
- Hospice care
- Inpatient rehabilitation hospitals
TRICARE may also cover care you receive at a long-term care hospital. Rather than provide custodial care, these hospitals are used to treat patients with serious medical conditions, like head trauma and complex wounds. Patients usually stay for 25 days or more. The length of time and care received helps them improve and return home. Be sure to talk to your regional or overseas contractor if you have questions.
As outlined in the TRICARE Plans Overview, certain health care services require pre-authorization. Keep in mind that some services may be limited or unavailable overseas. You should also contact your TRICARE contractor who can provide more information about services that may be available in your area.
What options exist outside of TRICARE?
If you need long-term custodial care, learn what options are available.
Some TRICARE beneficiaries may qualify to purchase long-term care insurance through the Federal Long Term Care Insurance Program (FLTCIP). This program may cover up to 100% of your daily benefit amount for care you get at your home, a nursing home, and assisted living facility. As outlined on the Office of Personnel Management (OPM) website, most federal employees, active duty service members, retirees, and qualified family members are eligible to apply for insurance coverage under the FLTCIP. For more on the FLTCIP, you can refer to the Long Term Care section on the OPM website.
Did you know that there are health care providers in the Health Insurance Marketplace who cover long-term custodial care? You may also qualify to purchase long-term care insurance through a commercial insurance program. Check for providers in your area at HealthCare.gov.
Last Updated 10/14/2021